title: Sublingual microcirculatory changes during transient intra-abdominal hypertension--a prospective observational study in laparoscopic surgery patients.
abstract: BACKGROUND
  Microvascular alterations and intra-abdominal hypertension are both involved in development of organ failure. It is not known whether increased intra-abdominal pressure (IAP) is associated with microcirculatory perfusion derangements.
  
  
  OBJECTIVE
  Transient increase in IAP induced by pneumoperitoneum affects sublingual microcirculation.
  
  
  METHODS
  16 laparoscopic cholecystectomy patients were studied. Sidestream dark field (SDF) imaging was used to evaluate sublingual microcirculation. Microcirculatory videos were done before surgery, at least 15 minutes after initiation of pneumoperitoneum and 1 hour after the pneumoperitoneum. Microcirculation cut-off value for vessels was 20 μm.
  
  
  RESULTS
  IAP was held at 12.6 (from 12 to 14) mmHg, mean (SD) duration of pneumoperitoneum was 41 (14) minutes. At the baseline, mean total vascular density was 18.8 (2.6) and perfused vessel density 13.2 (2.9) per mm². Proportion of perfused vessels was 59 (11) % and microvascular flow index 2.2 (0.4). Median (IQR) heterogeneity index was 0.6 (0.4-0.9) and mean De Backer score 13.6 (1.5). Increase in IAP did not cause significant changes in sublingual microcirculatory parameters.
  
  
  CONCLUSIONS
  Transiently increased IAP due to pneumoperitoneum does not affect sublingual microcirculatory blood flow and vessel density in patients undergoing laparoscopic surgery. However, the low proportion of perfused vessels indicates the prevalence of perioperative microcirculatory deficiency in these patients.
authors.affiliation: Department of Anaesthesiology and Intensive care, University of Tartu, Tartu University Hospital, Tartu, Estonia.
authors.forename: Liivi
authors.initials: L
authors.lastname: Maddison
authors.affiliation: Department of Anaesthesiology and Intensive care, University of Tartu, Tartu University Hospital, Tartu, Estonia.
authors.forename: Kairi Marie
authors.initials: KM
authors.lastname: Riigor
authors.affiliation: Department of Anaesthesiology and Intensive care, University of Tartu, Tartu University Hospital, Tartu, Estonia.
authors.forename: Juri
authors.initials: J
authors.lastname: Karjagin
authors.affiliation: Department of Anaesthesiology and Intensive care, University of Tartu, Tartu University Hospital, Tartu, Estonia.
authors.forename: Joel
authors.initials: J
authors.lastname: Starkopf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000150:complications*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000150:complications*; D011446:Prospective Studies
keywords: Microcirculation; SDF imaging; intra-abdominal hypertension; intra-abdominal pressure; laparoscopic surgery